Form 31-014 - Iowa Sales Tax Exemption Certificate - Credit Application - 2006 Page 2

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Principal Suppliers with whom you have established credit
Name
Phone
Street Address/City/State/Zip
Fax
Name
Phone
Street Address/City/State/Zip
Fax
Name
Phone
Street Address/City/State/Zip
Fax
Name
Phone
Street Address/City/State/Zip
Fax
Principal Owner(s); Partners or Officers
Name
SS#
Title
Name
SS#
Title
Name
SS#
Title
All Purchases become due and payable on the 15th of the month following the invoice date or on specific terms
designated on the invoice. Any invoice not paid within the terms will be considered past due. Purchaser agrees to pay
a service charge of 2% per month (24% annually) on all balances past due. The undersigned personally guarantees all
obligations to your company or companies extended as a result of this application for credit and it is hereby agreed,
that if such account is placed in the hands of an attorney or is collected by suit, or through probate proceedings,
promises to pay the principal and interest then due plus reasonable attorney’s fees and collection fees together with
all costs of court.
Signed (individually)
Signed (individually)
Certificate of Resale
The undersigned hereby certifies that all tangible personal property hereafter purchased by him is for purposes of
resale, and assumes liability for payment of Retailers’ Occupation Tax with respect to receipts from the resale of this
property to users or consumers. This certificate shall be considered a part of each order which we shall give, unless
such order otherwise specifies.
Firm Name
Date
Signature of Purchaser/Authorized Agent
OFFICE USE ONLY
0193-8096
HSC Location Submitting App 1 2 3 5 7 8 9 10 12
Certificate of Registration
Certificate of Registration
Salesman Code
Holt Supply Number
Number of Purchaser
SPS #
Holt Supply Contact

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